Original Article

原 著

A Trial Calculation of How Many Newly Graduated Nurses
can be Trained at National Hospital Organization Facilities
that Satisfy Provisional Standards on Desirable Educational Systems
Mieko Ozawa 1
Chiyako Hirose 3
Takako Takaya 5

Masayuki Mizuno 1
Harue Masaki 4
Keiko Takeo 1Ken’ichiro Nakashima 2
Ekiko Sato 5

1 National College of Nursing, Japan ; 1-2-1 Umezono, Kiyose-shi, Tokyo, 〒 204-8575, Japan
2 Japan College of Social Work
3 Japanese Nursing Association
4 Chiba University
5 St. Luke’s International Hospitalozawam@adm.ncn.ac.jp【Abstract】 The report from“Study Group on Improving the Clinical Capabilities of Newly Hired Nurses,”published by the Japanese Ministryof Health, Labour and Welfare in March 2004, outlines the goals and guidelines for the education of newly hired nurses. How many hospitals areproviding acceptable education as proposed in this report and how many nurses can be educated at these facilities, however, remains unknown.
On the basis of this report, we recently conducted a survey of the educational support systems and learning environments for newly hired nurses
at a significant number of hospitals located throughout Japan. We then created provisional standards for those educational systems and learning
environments deemed desirable at hospitals providing education to newly graduated nurses. We also sought to find how many hospitals satisfy thesestandards and how many nurses could be educated at these hospitals. In 2005, we conducted a survey of all hospitals in four Japanese prefectures;Tokyo, Kanagawa, Osaka, and Hyogo（Survey A）, and all member hospitals of the National Health Organization, NHO（Survey B）. The response
rate of Survey A drastically differs from Survey B, so we used a different calculation to quantify the results. We developed provisional standards
based on current status, and used this original standards for both calculations. This article mainly reports on the results of the NHO survey. The
analysis was based on the survey results from 109 NHO hospitals, representing 72.2％ of the total number of NHO hospitals. The tentative standard
score（range 0-10）was based on the sum of ten questionnaire items. Our calculation found that the number of hospitals with a tentative standard
score of 9 or higher was 50, the number of new graduates receiving training in 2004 was 817. The number of trainable new graduates（10％ of thetotal number of nurses）was 992. At the 82 hospitals with a tentative standard score of 8 or higher, the number of new graduates receiving training
in 2004 was 1,361, and the number of trainable new graduates（10％ of the total number of nurses）was 1,633. It is an option that those hospitals
deemed to provide superior training will develop model projects to promote the education of newly hired nurses.

【Keywords】 newly graduated nurses，educational support systems，learning environments，questionnaire survey，Japan

provided at professional work environments and the level of theIntroduction

capabilities of new graduates from nursing schools has been
expanding.

As medical care becomes more complex, the level of

Ibe et al.（1999, 2000）conducted studies on the postgraduate

clinical nursing knowledge and skills required at hospitals

clinical education of nurses. This study examined the optimalhas been rising, and the volume and intensity of nursing work

clinical training for new graduates from nursing schools, andhas also been increasing. This trend is due to the rising age of

how these graduates were received at workplaces. This study

patients, and an increase in patients’ailments while the average

pointed out that there were many nurses who had no experience

hospitalization periods become ever shorter. These trends

with nursing techniques or skills that are highly invasiveare even more marked in the United States where patients’during their pre-graduate clinical training. These new nurses,

hospitalization periods have been decreasing drastically（Goode

therefore, faced the necessity of dealing with such techniques or

et al., 2004）. In Japan, the gap between the level of basic nursing

developing such skills for the first time after actually starting to− 3 −J Nurs Studies N C N J Vol. 5 No. 1 2006

before graduation and clearly presented the goals to be achieved

work in a clinical setting.
Other studies have suggested that newly hired nurses are

by nursing students. Clinical training plays a significant role

involved in a high percentage of adverse patient incidents, andin the mastering of nursing skills. The said report referred tothat patient safety can be undermined by the lack of experience

expectations and issues related to clinical training and problemsof newly hired nurses. Kawamura et al.（2000, 2001）analyzed

found in the systems of education at universities and training

11,148 mistakes and near-misses involving nurses. Analysis

facilities, and proposed measures to be taken to resolve thoserevealed that the mistakes and near-misses were often related toproblems. The greatest issue in the clinical training systems

the following types of work:（1）procedures and skills at giving

pertains to the difficulty in providing nursing care, for patients

injections（including drip infusion）,（2）knowledge of drugs

or other subjects, by nursing students（who have not yet been

for injection,（3）oral drug treatment,（4）blood transfusion,

licensed for nursing）due to the recent increased sophistication（5）manipulation of I.V. fluids and syringe pumps, and（6）of medical care（requiring high levels of skill to be masteredmanipulation of respirators. The same researchers studied andby nurses）. This problem is inherent in the current nursing

analyzed when and where newly hired nurses learned a set of

education system and is related to the recent increase in patient

100 skills related to the aforementioned six types of work. Theyawareness of their rights. Regarding this connection, the reportfound that, on the whole, the percentage of those skills learned

states:“It is desirable and necessary that the method of training

during their pre-graduate training was low.

for the mastery of skills involving invasive intervention is clearly

In 2002, the Japanese Nursing Association（JNA）issued the“Survey Report on Basic Nursing Skills of Newly Graduateddefined at individual facilities and that a valid system for training
is established jointly by universities and medical facilities.”

Nurses in 2002”（JNA, 2003）. This report dealt with the clinical

To resolve this issue, in March 2003, the Ministry of Health,capabilities of new nurses immediately after being hired and 3

Labour and Welfare（MHLW）issued“Report from the Studymonths later. It also investigated the extent to which the basic

Group on Skill Training in Basic Nursing Education”（MHLW,

nursing skills had been acquired during pre-graduate clinical2003）. This report presented, among other things, fundamental

training. The report demonstrated that:（1）at the time ofviews about nursing skills to be learned by students during

recruitment, the number of nursing skills the newly recruitedclinical training and how to teach invasive nursing skills. On thenurse was confident in practicing without assistance was small;basis of the“basic nursing skills”listed in the aforementioned（2）at 3 months after recruitment, nurses tended to be able to

MEXT report（MEXT, 2002）, this report classified basic nursing

practice the skills learned during pre-graduate clinical training,skills to be learned by students during clinical training into

without assistance;（3）nurses had relatively little experience

three levels for the purpose of improving the effectiveness ofwith invasive nursing procedures during pre-graduate clinicalclinical training and ensuring the safety of patients cared for bytraining; and（4）the capability to practice the frequently

nursing students. The three levels are: Level 1（skills which canrequired skills improved following on-the-job training（OJT）,

be practiced by students alone under the advice and instruction

etc., even when such skills had not been practiced during pre-of teachers and registered nurses）, Level 2（skills which can be

graduate clinical training.

practiced under direct instruction and supervision of teachers

On the basis of the findings from these several reports, it

and registered nurses）, and Level 3（skills to be learned byis clear that nursing knowledge and skills, especially invasive

observing the conduct of nurses or physicians）. Nursing skills

nursing skills, are difficult to master in under graduate basic

that the students do not practice during pre-graduate clinicalnursing education. Since 1999, the Ministry of Education,

training will become indispensable once they become registered

Culture, Sports, Science and Technology（MEXT）has beennurses, i.e. after graduation from school.

sponsoring a workshop known as the“Study Group on Future

In March 2004, the MHLW issued“Report from the the Study

Nursing Education,”whose objective it is to encourageGroup on Improving the Clinical Capabilities of Newly Hireddiscussions about linkage and cooperation between universities

Nurses”（MHLW, 2004）. This report discusses the nursing

and medical facilities with the goal of improving basic nursing

skills, knowledge, and attitudes that needed to be masterededucation（MEXT, 2001）. In March 2002, the MEXT issued

during the first year after graduation from nursing schools. Thea report entitled“To Improve Education of Nurses’Practicalreport also proposed standards of educational support for new

Capabilities at Universities”（MEXT, 2002）. Regarding thegraduates. These standards included matters related to staff incurriculum for undergraduate nursing education, this reportcharge of nursing education, training programs, and educational

summarized the skills that should be learned by nursing students

methods.

国立看護大学校研究紀要 第 5 巻 第 1 号 2006 年− 4 −In Japan, the average percentage of drop-out rate for newly
hired nurses（15.9%）is higher than that of the general nursing

health care for the Japanese government. This paper mainly
reports the results of the NHO survey.

population（11.6%）（JNA, 2004）. This suggests that it is
Methoddifficult for newly hired nurses to adapt to their workplaces.
It is an urgent challenge in nursing administration to establish

Major items of the survey were:（1）characteristics ofa system through which the knowledge and experience of
newly hired nurses, which are insufficiently acquired during

individual hospitals,（2）numbers of nurses and their careers,

nursing school education, be supplemented with post-graduate（3）numbers of newly hired nurses and the training for suchtraining. Further, it should be assured that newly hired nurses

nurses,（4）staff in charge of training,（5）training programs

can provide safe and high quality nursing services. Althoughfor newly hired nurses, and（6）acceptance of trainees fromawareness of the necessity of promoting training for newly hired

other hospitals. The goals of education for newly hired nurses

nurses has been increasing across the nation, concrete measures

include acquisition of the skills for supporting patients intaken towards meeting this goal vary greatly depending on the

regards to eating, urination/defecation, activity/resting, andeducational background and the circumstances of individual

grooming/dressing（MHLW, 2004）. To assure that newly hired

facilities.

nurses can be trained to master these skills during on-the-job“Report from the Study Group on Improving the Clinicaltraining, it seems necessary to carry out post-graduate training in

Capabilities of Newly Hired Nurses”（MHLW, 2004）presents

individual wards. We therefore also investigated the number ofthe goals and guidelines for education of newly hired nurses. But

wards and the number of nurses working at night in such wards

the number of facilities providing acceptable education to newlyat each hospital.
Regarding the ethical aspects of this survey, we made it clear

hired nurses and the number of nurses that can be educated atthat the decision as to whether or not to answer the questions

these facilities remains unknown.
On the basis of the previous report（MHLW, 2004）, we

could be made at the discretion of each hospital and that refusal

conducted a survey of the educational support systems andto cooperate with this survey would cause no disadvantage to thelearning environments for newly hired nurses at several

hospital concerned. We also promised not to use any expression

hospitals. We then created tentative standards for the educational

allowing the identifi cation of any particular facility in thesystem and learning environments desired for hospitals

publication of our survey results. A document outlining theseproviding education to newly hired nurses. We then considered

ethical considerations and guarantees was included with each

how many hospitals satisfy the standards and how many nurses

mailed questionnaire.
The questionnaire for survey A was delivered to 1,935

can be educated at these hospitals.
In Japan, there is no governmental standard as regards the

hospitals and responses were collected from 440 hospitals

education and training program for newly hired nurses that

（22.7%）. The response collection rate was high for national

discriminates between good facilities and others. The Nursing

high-level specialized medical care centers operated by theDivision of the MHLW has discussed this for several years,

MHLW,“National Centers”（80.0%）. The response rate fromand issued previous reports. The government wishes to make ahospitals operated by independent administrative corporations

standard for newly registered nurses’training programs, but theywas 65.0% ; 57.1% for hospitals attached to national university

are still trying to establish a standard which is suitable for the

corporations, national university hospitals; 54.4% for hospitals

current situation. This research aims to make original provisional

operated by local governments, and 51.9% for hospitals operated

standards based on the current situation, and calculate how manyby private universities. The response collection rate was as low

newly graduated nurses were/can be trained at hospitals thatas 17.5% for hospitals operated as medical corporations, which

satisfy provisional standards. This research makes a new phaseaccounted about 60% of all facilities investigated. The collectionof governmental policy.

rate did not differ markedly among different prefectures, ranging

In 2005, we conducted a mailed questionnaire survey offrom 21 to 24%.

all hospitals in four Japanese prefectures（Tokyo, Kanagawa,

In Survey B, all hospitals operated by the NHO were

Osaka and Hyogo）（Survey A）and all member hospitals ofinvestigated. The questionnaire for Survey B was mailed to 133

the National Health Organization , NHO（Survey B）. The four

facilities, excluding the hospitals located in the four prefectures

prefectures were selected based on the training condition. The

investigated in Survey A. Responses were collected from 102

NHO plays a key role in the implementation of policy-basedof these hospitals（76.7%）. Analysis was based on responses− 5 −J Nurs Studies N C N J Vol. 5 No. 1 2006

from these 102 hospitals plus the 7 hospitals of the NHO which

midwives were 471（permanent employees）and 8（part-timers）.

had returned Survey A questionnaires with their names entered

In 2004, 55 midwives were hired, and the number of new

into the responses（109 hospitals in total）. The 109 hospitals

graduates hired as midwives was 39. The numbers of licensed

analyzed in Survey B account for 72.2% of all the NHO

practical nurses（LPN）were 1,224（permanent employees）andhospitals（n = 151）.

63（part-timers）. In 2004, 40 LPN were hired, and the numberof new graduates hired as LPN was 7.
The total number of nursing staff members（nurses, public

Results

health nurses, midwives and LPN）was 19,832. The total
Characteristics of individual hospitals

number of new graduates hired as nurses, public health nurses,

Fourteen（12.8%）of the facilities analyzed were hospitals
with special functions, 47（43.1%）were hospitals supporting

midwives and LPN was 1,387, accounting for 7.0% of the total
nursing staff.

community medical care, and 39（35.8%）were hospitals

The mean length of time served by nursing staff members

designated for clinical training. Accreditation by the Japanat each hospital was 10.2 years. This duration was less than 3

Council for Quality Health Care has been obtained by 18

years at 1 hospital（0.9%）, 3-6 years at 11 hospitals（10.1%）,
6-10 years at 37 hospitals（33.9%）, 10-15 years at 38 hospitals

hospitals（15.6%）.
When the range was analyzed, hospitals with 300-399 beds

（34.9%）, and over 15 years at 13 hospitals（11.9％）.

accounted for the highest percentage（31.2%, 34 hospitals）,
followed by hospitals with 400-499 beds（24.8%, 27 hospitals）.

New graduates

The mean number of beds per hospital was 370.5. The total

Statistics on those who had graduated less than one year

number of approved beds in all respondent hospitals was 40,380.

earlier from nursing school were analyzed. At 108 hospitals,

Of these, 77.1%（31,114 beds）were for routine care, 4.1%

excluding the 1 hospital that did not provide an answer, the（1,636 beds）were for chronic care, 9.2%（3,735 beds）were

number of new graduates assigned（total: 1,386）was 1,325 infor psychiatric patients, 0.0 %（18 beds）were for infectedwards（95.6%）, 20 in outpatient clinics（1.4%）, 35 in operating

patients and 6.9%（2,790 beds）for tuberculosis patients. Whentheaters（2.5%）and 6 in other units（0.4%）. The total number

the number of wards per hospital was analyzed, hospitals withof nursing staff members at each of the 109 hospitals is almost

5-9 wards accounted for the highest percentage（65.1%, 71

equal. The above-shown percentages may, therefore, be viewed

hospitals）, followed by hospitals with 10-14 wards（22.0%, 24

as almost precisely reflecting the current trend in allocation of

hospitals）. The largest number of wards per hospital was nearly

new graduates into various units of hospitals.

20.
When the number of inpatients as of December 1, 2004 wasanalyzed, hospitals with 200-299 inpatients accounted for thePercentage of new graduates among the total nursing staff inindividual wards

highest percentage（34.9%, 38 hospitals）, followed by hospitals

Each hospital was asked to provide the highest and lowest

with 300-399 inpatients（28.4%, 31 hospitals）. The mean

percentages of new graduates among the total nursing staff innumber of inpatients per hospital was 316.2.

individual wards.

Nursing staff

10% at 23 hospitals（23.5%）, ≧ 10 and ＜ 20% at 49 hospitals

The highest percentage of new graduates per ward was ＜The number of nursing staff members counted as of April 1,（50.0%）, ≧ 20 and ＜ 30% at 19 hospitals（19.4%）, ≧ 30 and2004 at the 108 hospitals analyzed did not include those from

＜ 40% at 2 hospitals（2.0%）, ≧ 40 and ＜ 50% at 3 hospitals

one hospital where the corresponding entry was not provided in（3.1%）and ≧ 50% at 2 hospitals（2.0%）.

the returned questionnaire. At those that did answer, there were

The lowest percentage of new graduates per ward was smaller

17,394 permanently employed nurses and 669 part-time nurses

than 10% at 72 hospitals（73.5%）and the same or greater（converted on the basis of permanently employed nurses）. In

than 10% and smaller than 20% at 21 hospitals（21.4%）. At

2004, 2,036 nurses were hired and the number of new graduates

5 hospitals, the percentage of new graduates per ward was thehired was 1,339. The numbers of public health nurses were 3

same or greater than 20%, at a minimum.

（permanent employees）and 0（part-timers; converted on the

When we inquired about the ideal percentage of new

basis of permanent employees）. In 2004, 2 public health nurses

graduates among the total nursing staff members per ward, awere hired, and they were new graduates. The numbers ofmajority（77 hospitals, 78.6%）indicated the ideal percentage to

国立看護大学校研究紀要 第 5 巻 第 1 号 2006 年− 6 −be 10 to 19%, and the mean percentage was 12%.

from the entire nursing staff.

Educational environments

Availability of checklists for the assessment of goal

When asked about the availability of libraries, 8 hospitals

achievement by new graduates（7.3%）believed they had a satisfactory library, 43 hospitals

When asked about the availability of checklists for use by（39.4%）felt they had a relatively satisfactory library and 55

educational staff or trainers in assessment of the goals achieved

hospitals（50.5%）answered that they did not have a satisfactoryby new graduates, 105 hospitals（96.3%）answered that theylibrary. When asked about the availability of internet connection

had such checklists while 4 hospitals（3.7%）had no such lists.

services, 12 hospitals（11.0%）reported satisfactory services,
26 hospitals（23.9%）relatively satisfactory, and 69（63.3%）

Educational programs for new graduates
Of all respondent hospitals, 107（98.2%）had educational

reported unsatisfactory internet connections. The availabilityof skill training space was said to be satisfactory at 1 hospital

programs for new graduates hired as nursing staff.

（0.9%）, relatively satisfactory at 10 hospitals（9.2%）, andThe duration of the off-job training for new graduates was

unsatisfactory at 96 hospitals（88.1%）.

most frequently 7-10 days per year（mean: 8.2 days per year）.

Training for new graduates（ linkages with other facilities）

Educational considerations and mental support systems

When asked about training for new graduates hired as nursing

When asked about mental health support systems for new

staff, 7 hospitals（6.4%）answered that they were providing

graduates, 59 hospitals（54.1%）answered that they weretraining jointly with other hospitals, 32 hospitals（29.4%）

providing support systems, while 37 hospitals（33.9%）were

were utilizing the training provided by the Japanese Nursing

providing no such support. Only one hospital had experts

Association or others, and 66 hospitals（60.6%）had no linkage

in mental health support for new graduates（e.g., liaison

with an outside organization in training new graduates.

nurses）. At 26 hospitals（23.9%）, some measures were being
taken to ensure the labor force or manpower needed for theStaff in charge of education

implementation of training or education for new graduates hired

Educational staff in the nursing department

as nursing staff was in place.

Of all respondent hospitals, 92（84.4%）had staff in chargeof education within the nursing department and 17（15.6%）

Development of the nursing care capabilities of new graduates

had no such staff within the nursing department. Staff members

Each hospital was asked to make a subjective evaluation of the

responsible for education alone were stationed at 2 hospitals

nursing care capabilities possessed by new graduates at the time

（2.2%）, staff responsible for education and other duties wereof recruitment and again at 3, 6 and 9 months after recruitment

employed at 86 hospitals（93.5%）.

if the capability at one year after recruitment was deemed to be

Educational staff in each ward

100%. The time course of development in caring capability did

Seventy nine hospitals（72.5%）had educational staff in eachnot differ markedly between Surveys A and B. The capability

ward and 29 hospitals（26.6%）had no educational staff in

was only about 10% at the time of recruitment relative to the

any ward. Of the 79 hospitals, 77（97.5%）had staff members

capability at 12 months. It was about 40% at 3 months, about

responsible for education and some other duties. No hospital had

60% at 6 months and about 80% at 9 months, each relative to thestaff members responsible for education alone. In total, 71.7%

capability at 12 months after recruitment.

of all wards（517 out of 721 wards）had some educational staff
Discussion

members.
Trainers in each ward
Of all respondent hospitals, 105（96.3%）had preceptors on

Developing provisional tentative standards

each ward, and only 1 hospital（0.9%）had no such trainer.

Considering the current status of educational systems for

When asked about the method of assigning trainers, a majority

new graduates, the number of hospitals that provide satisfactory（75.2%, 79 out of 105 hospitals）answered that they allocatededucational systems was calculated. We would like to distinguish

one trainer to each new graduate for the purpose of continued

between“satisfactory hospitals”and other hospitals whentraining, and the second highest percentage of hospitals（23.8%,

setting provisional standards.

25 hospitals）assigned the trainer on successive days, selecting− 7 −Even if these provisional standards are met, it would not

J Nurs Studies N C N J Vol. 5 No. 1 2006

necessarily mean that the training of newly hired nurses is being

nursing departments. Even among hospitals where educational

conducted satisfactorily. Conversely, even when these standards

staff were available, the number with staff responsible solely

are not met, satisfactory training of newly hired nurses may befor education was low（21.8% in Survey A and 2.2% in Survey

accomplished through measures unique to individual hospitals.

B）. Therefore, in the present study, one point was awarded

Our evaluation is aimed at examining how many hospitals satisfy

to hospitals where at least one member of staff for education

the conditions listed as“indispensable”or“desirable”in the（irrespective of whether or not that person responsible solely forreport from the MHLW（MHLW, 2004）, and to what extent theyeducation）was available.
This criterion was satisfied by 82.3% of hospitals in Survey A,

are being satisfied.
To make these provisional standards, we checked the
distribution of each item carefully, and identified the items forand 84.4% of hospitals in Survey B.

（ 2）Educational staff stationed in each ward

which 50-90% of all hospitals in Survey A and B have. If we

None of the hospitals surveyed had staff responsible solely

use the items that almost all hospitals have adopted, or thosefor education stationed in each ward. One point was awarded tothat many hospitals could not adopt, we are unable to classify

hospitals where at least one staff in charge of education（evensatisfactory hospitals. But by considering very importantwhen he/she had some additional duties as well）was present.
This criterion was satisfied by 73.4% of hospitals in Survey A,

components, such as preceptor’s clinical careers and training
systems for invasive care, we set strict standards. In Japan, it

and 72.5% of hospitals in Survey B.

is diffi cult to master invasive care procedures during under（ 3）Trainers（ preceptors and others）with a clinical career ofgraduate education（Kawamura et al., 2001; JNA, 2003）, andover 3 years to be stationed at each ward

many new nurses make mistakes or near-misses early in their

The Report（MHLW, 2004）recommends that it would becareers（Kawamura et al., 2000）. So, we tried to select hospitals

desirable to have trainers with a clinical career experience of at

at which new nurses can master these invasive care procedures

least 2 years or someone who is capable of providing not only

through group education and OJT.

education about knowledge and skills, but also emotionally

We surveyed all hospitals in four prefectures, and all hospitals

stable education and training. This means that it is essential tounder the NHO. The response rate was high for National Centersselect trainers from suitable candidates with a clinical career（80.8%）, hospitals operated by independent administrative

experience of over 3 years. Therefore, one point was awarded tocorporations（65.0% in Survey A, and 76.7% in Survey B）,

hospitals where each ward had some trainers（preceptors, andhospitals operated by local governments（54.4%）and hospitals

others）selected using both of the following criteria:（1）nursing

operated by private universities（51.9%）. Accordingly, ourstaff with a clinical career experience of over 3 years, and（2）standards especially reflect the current status of the majority ofnursing staff capable of providing both advice and support.
This criterion was satisfied by 33.4% of hospitals in Survey A,

public hospitals that are training many new nurses.
The results of our analyses revealed that the following 10
items should be adopted in the tentative standards. Realistic

and 46.8% of hospitals in Survey B.

（ 4）Training programs for cultivation of trainers

criteria for the practical evaluation of individual items were

One point was awarded to hospitals with their own training

prepared on the basis of the survey results. We additionallyprograms or those that had access to outside training programs.

attempted to prepare standards refl ecting the characteristics

The desirable contents of the training were not investigated in

of individual wards and calculated the number of newly hired

the present study, as improvement in this area can be expected innurses who can be trained. However, since this survey was

the future.

conducted on hospitals（not on individual wards）and because

This criterion was satisfied by 65.9% of hospitals in Survey A,

the entries made by respondent hospitals about the number

and 79.8% of hospitals in Survey B.

of wards and the number of nurses working in the night shift（ 5）Educational programs for new graduates hired as nurses

contained some errors requiring correction, the results of these

One point was awarded to hospitals where training programs

additional attempts were not incorporated into the tentative

for new graduates hired as nurses were available or where newstandards presented in this study.

graduates hired as nurses were undergoing training at their own（ 1）Staff responsible only for education stationed at the Nursing

or some outside hospitals.
This criterion was satisfied by 78.6% of hospitals in Survey A,

Department
The Report（MHLW, 2004）recommends that some staff
members responsible solely for training be stationed within

国立看護大学校研究紀要 第 5 巻 第 1 号 2006 年

and 98.2% of hospitals in Survey B.

（ 6）Manuals to be used for training in nursing care

− 8 −The Report（MHLW, 2004）points out:“Each hospital should（ 10）Emotional support to new graduates

prepare nursing standards, manuals, etc., for use in the training

The Report（MHLW, 2004）also states:“It is desirable thatof newly hired nurses.”One point was awarded to hospitals

a support system（consultation for new graduates, etc.）by

where the director of nursing felt as satisfactory or almost

specialists in emotional support be established.”The percentage

satisfactory manuals were available.

of hospitals with specialists available to give emotional support

This criterion was satisfied by 93.2% of hospitals in Survey A,
and 99.1% of hospitals in Survey B.

was less than 20%. Therefore, one point was awarded tohospitals which indicated that such support was available.

（7）Group education or clinical education in nursing skills that

This criterion was satisfied by 50.9% of hospitals in Survey A,
and 54.1% of hospitals in Survey B.

can affect patient safety
The Report（MHLW, 2004）points out:“It is advisable thathighly invasive nursing interventions by newly hired nurses be

The total of the scores for the items mentioned above isperformed in steps after adequately confirming that these nurses

called the tentative standard score. The number of hospitals

have learned these interventions well during group education,that responded to all of the 10 questions was 269 in Survey A ,etc.”One point was awarded to hospitals where group education

and 85 in Survey B. In both Survey A and B, the peak tentative

had been carried out and OJT had been provided on at least 9

standard score was 9.

of the 11 nursing skills considered to be particularly related to

In Survey B, the tentative standard score was 9 or higher at 28
hospitals, accounting for 32.9% of the 85 hospitals for which thepatient safety.
The 11 nursing skills decided upon are: injection procedureand skills, drip infusion procedure and skills, knowledge

score could be determined. The number of new graduates hired
as nurses at these 28 hospitals in April 2004 was 460.

about drugs for injection, knowledge about oral dose drugs,

The tentative standard score was 8 or higher at 46 hospitals,

transfusion procedure and skills, I.V. fluid pump manipulations,accounting for 54.1% of the 85 hospitals mentioned above. At

syringe pump manipulations, respiratory manipulations, carethese 46 hospitals, 766 new graduates were hired as nurses inof emergency/critical patients, prevention of infection, and risk

April 2004.

management.
This criterion was satisfied by 38.2% of hospitals in Survey A,

A trial calculationand 45.0% of hospitals in Survey B.

The percentage of nurses who can be trained at each hospital（ 8）Availability of checklists for goal achievement assessment ofis set at 10%. This percentage is based on the finding fromnew graduates

this questionnaire survey that the ideal percentage of new

The Report（MHLW, 2004）states:“Evaluation should be

graduates among all the nurses in a given ward averaged 12%.

made using a table of evaluation related to achievement ofThis percentage is consistent with the results of Survey A, andgoals（self-evaluation and third party evaluation）.”One point

previous study（Saito et al., 2001）. Considering that some

was awarded to hospitals where a checklist for evaluation waspercentage of nurses are assigned to units other than wards,

available.

we judge that assigning 10% of all new graduates to wards

This criterion was satisfied by 82.5% of hospitals in Survey A,
and 96.3% of hospitals in Survey B.

will allow the smooth training of newly hired nurses at wards,
without posing an excessive burden on other nurses.

（ 9）Availability of certain special educational environments

The total number of hospitals operated under the NHO was

The Report（MHLW, 2004）further notes that it will be useful

151. Calculation of the tentative standard score was possible

to consider adopting methods of learning making use of IT, etc.,

for 85（56.3%）of these hospitals. The tentative standard scorein connection with the introduction of IT into training for newly

was 9 or higher at 28 hospitals, accounting for 32.9% of the 85

hired nurses. Regarding the availability of“skill training space,”

hospitals for which calculation of the tentative standard score80-90% of the hospitals indicated that the space available

was possible. The number of new graduates hired as nurses at

was inadequate. This factor was therefore excluded from thethese 28 hospitals in April 2004 was 460. The total number ofanalysis. One point was awarded to hospitals where the director

nurses at 28 hospitals was 5,586; 10% of this number is 558.6.

of nursing believed the library and/or Internet connection to be

The tentative standard score was 8 or higher at 46 hospitals,

satisfactory or relatively satisfactory.

accounting for 54.1% of the 85 hospitals for which calculation

This criterion was satisfied by 65.9% of hospitals in Survey A,
and 57.8% of hospitals in Survey B.

of the tentative standard score was possible. The number of new
graduates hired as nurses at these 46 hospitals in April 2004 was− 9 −J Nurs Studies N C N J Vol. 5 No. 1 2006

766. The total number of nurses at 46 hospitals was 9,194; 10%

somewhat satisfactory nursing care.

of this number is 919.4.

At present, each new graduate hired as a nursing staff member
is counted as one member of the nursing staff in the context

This value was divided by the number of hospitals（85of the upper limit of the staff number at a given hospital. Thishospitals）for which the tentative standard score could bepractice places a load on both new graduates and the clinicalcalculated and multiplied by the total number of hospitals（151）,

team. When patient safety is discussed, education of nursing

to yield the following numbers:

staff is indispensable. It is desirable for the central government

Number of hospitals with a score of 9 or higher: 50

to devise measures to ensure the safety of nursing care.

（= 28 × 151/85）
Number of new graduates hired as nurses: 817

The limitations of this research（= 460 × 151/85）

Our evaluation is aimed at examining how many hospitals

Number of trainable new graduates: 992

satisfy the conditions listed as“indispensable”or“desirable”in（= 558.6 × 151/85）

the report from the MHLW（MHLW, 2004）. The questionnaire

Number of hospitals with a score of 8 or higher: 82

was disseminated to all hospitals in four prefectures and（= 46 × 151/85）

all hospitals under the NHO. This means the results show

Number of new graduates hired as nurses: 1,361

the present situation. If the situation surrounding medical（= 766 × 151/85）

facilities changes, our provisional standards should be changed.

Number of trainable new graduates: 1,633

Our provisional standards are not absolute but relative, and（= 919.4 × 151/85）

changeable according to the real situation. We intended toestimate the number of new nurses who can get suitable new

On the percentage of nurses who can be trained at each facility

training using the result of four prefectures and NHO. It is an

We estimated the percentage of nurses who can be trained

option that those hospitals deemed to provide superior training

at each hospital to be 10%. In Japan, life-long employment iswill develop model projects to promote the education of newly

usual, especially in the facilities operated under the NHO which

hired nurses.

is under the Japanese government. Employee promotions andConclusions

pay increases are usually age-related. At most hospitals, newgraduates or other nurses are hired to fill vacancies arising fromretirements. Accordingly, it is difficult for each hospital to raise

At the request of the Nursing Division of the MHLW, wethe number of nurses on their staff. If each hospital can accept

have prepared tentative standards for the official recognition oftrainees without counting them as nursing staff members, this

hospitals providing training for new graduates hired as nurses.

percentage can go up more than 10%.

We calculated the number of new graduates who can be trainedSome hospitals that responded Survey A said they wereat individual hospitals by investigating all the NHO hospitals.

willing to accept trainees without counting them as nursing staff

The response collection rate was high at hospitals operated bymembers in connection with the cap on staff numbers. Some ofindependent administrative corporations include NHO. This

them also said that it is possible to accept trainees（about one

suggests that these medical facilities are highly concerned withtrainee on each ward）after the newly hired nursing staff at their

the promotion of training for new graduates hired as nurses. One

own hospitals accumulated a certain degree of experience（after

possible option based on the results will be for model projects toabout 7 or 8 months）if training is provided for well-defined

be conducted at these hospitals for the promotion of training foritems. At the time of recruitment, new graduates hired as nursing

newly hired nursing staff.

staff had only about 10% of the nursing care capability theywould possess 12 months after recruitment. Their capability was■ Acknowledgments

rated as being about 40% at 3 months, about 60% at 6 months

The authors are indebted to those hospitals that cooperated

and about 80% at 9 months after recruitment, each relative to thewith this survey and gave their time to provide us with theircapability rated at 12 months after recruitment. We depicted avaluable opinions. This study was carried out within the

productivity curve on the basis of the data colleted in a previous

framework of a series of studies pertaining to the promotion ofsurvey（Takeo et al., 2001）. The curve indicates that about 1

training for newly hired nursing staff under the financial support

year is needed for a new graduate to become able to provideof the MHLW Scientific Research Program for Fiscal 2004.

国立看護大学校研究紀要 第 5 巻 第 1 号 2006 年− 10 −

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Ibe, T.（principal researcher）（1999）. Kango kyouiku niokeru

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Nursing Education）,（chaired by Hirayama, A.）］.（insono seityou ya henka ni eikyou wo oyoboshita youin

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medical care（a study within the framework of the MHW− 11 −J Nurs Studies N C N J Vol. 5 No. 1 2006

国立病院機構における仮設認定基準を用いた新卒看護師育成可能人数試算
小澤三枝子 1
水野正之 1
中島健一朗 2
廣瀬千也子 3
正木治恵 4
5
5
1
佐藤エキ子
高屋尚子
竹尾惠子
1 国立看護大学校；〒 204-8575 東京都清瀬市梅園 1-2-1
2 日本社会事業大学
3 日本看護協会
4 千葉大学
5 聖路加国際病院【要旨】 2004 年 3 月に厚生労働省から出された「新人看護職員の臨床実践能力の向上に関する検討会報告書」には新人教育の到達
目標・指導指針が示されているが，実際にこのような新人教育を行っている施設が全国にどれくらいあるのか，そこで何人くらいの育成が可能なのかについてはわかっていない。そこで，厚生労働省報告書が新卒看護師研修施設として備えることが望ましいとする教育体制や学習環境について質問紙調査を行い，その結果をもとに 10 項目からなる仮設基準を作成，それを満たす施設がどの程度あるのか，そこで何人くらいの育成が可能なのか試算を行った。調査は，東京・神奈川・大阪・兵庫（調査 A）と，独立行政法人国立病院機構（調査 B）において 2005 年に行った。調査 A と調査 B とでは回収率の傾向が大きく違ったため，同じ仮設基準を用いたものの，異なる計算方法で試算を行った。ここでは，主として国立病院機構における調査結果を報告する。分析対象は 109
で，これは国立病院機構病院全体の 72.2％にあたる。仮設基準 10 項目の合計を仮設基準スコアとし，試算を行った。試算の結果，
仮設基準スコア 9 点以上の施設は 50 施設，育成している新卒看護職員数 817 人，育成可能新卒者数（看護職員の１割）は 992 人であった。仮設基準スコア 8 点以上でみると，該当施設は 82 施設，育成している新卒看護職員数 1,361 人，育成可能新卒者数は1,633 人であった。新人看護職員研修の推進にあたり，これらの医療施設でモデル事業を行うことも今後の可能性の一つであろう。

国立看護大学校研究紀要 第 5 巻 第 1 号 2006 年− 12 −